On Friday I talked about the winners, in light of the Supreme Court ruling. Inevitably if there are winners, there are losers. Thursday will close out the series talking about the specific implications for senior housing.
You can Read Part Part One Here
The Losers
1. Taxpayers
It has been said that, in effect, this is the single biggest tax increase ever implemented by the Federal government. Hardest hit will clearly be the middle class. Initially, it is clear the Affordable Care Act will add to the tax burden. What is less clear is what savings, if any, will be achieved, when they will be realized and if they will save money for the middle class as promised.
2. Drug Companies
In the short term, the drug companies have created an agreement with the government that, in effect, protects their bloated profits. The jury is still out on how long it will take for that agreement to crumble, but it will. For consumers, this is a mixed bag. Over time it will eliminate derivative drugs that are expensive but provide only marginal real benefits to patients. On the other hand, it will likely dampen the innovation of new drugs that could radically improve life.
3. Durable Medical Equipment Providers (DME’s)
Several times each year a story on Medicare fraud splashes into the news. Probably seven out of ten times, the fraud, involves DME providers. One government study indicates more than 10% of all DME dollars paid out are for fraudulent claims. We can look forward to ObamaCare coming down hard on DME. If all they do is reduce fraud that is great, but look for real claims to also be denied and delayed.
4. Physicians
There is ongoing pressure to reduce payments to physicians. They are an easy target as the general impression is that they are wealthy and by extension, overpaid. There is no doubt that some specialities can still make practitioners wealthy, but in truth, being a physician generally means a very nice living but it is no longer a guaranteed path to wealth.
5. Consumers
A few weeks ago I had a significant allergy attack. After a day of trying to push through it, I was nonfunctional. First thing in the morning I called my primary physician and had an appointment for later that same day. I got to my appointment on time and maybe 3 minutes after paying my co-pay I was ushered into the physician exam room and 3 minutes later the physician was there to see me. This happens because there is competition and significant reimbursement. I do not expect it to stay this good. There are already so many stories coming out of Canada and England of individuals having to wait weeks for a physician appointment for even serious (but not immediately life threatening) problems and long waits when the appointment day finally arrives.
Too Early to Tell
1. Skilled Nursing
There is no doubt that skilled nursing communities must continue to fight to protect their funding. Both Medicaid and Medicare dollars are at risk. I predict that within 10 years every single recipient of government healthcare dollars will receive their benefits through an HMO like entity. This will likely benefit top notch facilities and make life more difficult for the rest. It is my view that, in reality, Skilled Nursing faces essentially the same problems with or without ObamaCare.
2. Home Health
This one is really difficult to predict. It seems clear that Home Health actually provides the most bang for the buck and it feeds the instinctual desire people have to age in place. The flip side is that, home is a pretty easy target. Recipients do not speak as a single voice and providers are almost as equally fragmented.
3. Hospice
Ditto Home Health. Part 3 will be published on Thursday and will talk about the opportunities and risks for Senior Housing, which in this case mostly means assisted living.
Did I miss any losers? Do think my list is off base?
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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.
From LinkedIn Groups
Group: Senior Living & Care Professionals
Discussion: Does Senior Housing Win, Lose or Draw, with ObamaCare? Part 2-The Losers
I read your article. Interesting and good points. Every one is talking about how much doctors make, how expensive senior care is. How the good care should cost less. Does anyone ever thought that a plumber, electrician or A/C laborer makes more per hour than LPN or in many cases RN. And no liability and no high school requirement. They barely come to your door for less than $75/hr and one is lucky to get this price. I question why a painter in upper scale senior facility is paid $16-$18/ hr, where no high school is required but Maxim wants CNA to start at $8.50/hr, with high school requirement and CNA classes. Upper pay for CNA is $11.88- $12.50. There is something wrong with this picture.
Posted by Margaret Szalata
1. It’s the larest tax since the mid-90s, not ever.
2. There continues to be a push for generics over brand name drugs w/all ins plans
3. Patients are still getting their DMEs covered, but the approved providers are getting paid less and several were not accepted and are contracting with those who do have contracts with Medicare.
4. I am concerned about physicians not being compensated what is needed to run an office and serve their patients well. So far further cuts have been curtailed and over 130,000 are electronically connected.
5. I haven’t done a lot of research about other countries access to medical care, but when our dtr visited England 12+ years ago, and was ill, she got right in.
6. I agree the ACA has little to do with where NH care is going. Medicaid/Medicare $ are at risk d/t the economy and we babyboomers seem to be sicker earlier. The ACA wellness programs and the coordination of health care for dual eligibles will hopefully help us live healthier lives and reduce costs by needing less medical care – especially those who are in their 40s and 50s now. I agree that we are moving more toward HMOs.
7. Skilled home health is regulated. If patients are not happy, they need to tell their doctor. Private home health care is different, but once again, if you aren’t happy, switch, and the ACA has nothing to do with it.
8. Hospices are covered by Medicare or private insurance. They are regulated. Their biggest problem seems to be staffing as with home health agencies.
Emilie hit all the key points, in my opinion, correctly. Based on what I know of ACA, her points are based on fact not supposition as in the article.
Agree with Emilie on most of her points. Also question why you list taxpayers as Losers in this. The middle class could save a ton of money. Where did you get this info from? Fox Talking Points?
The reason I list tax payers as losers is that for most of us, who pay taxes and are already covered by an employer health plan we will not receive any additional benefits, but the government will incur significant additional costs which sooner or later impacts every tax payer.
I am open though to hearing a different point of view if you think I am wrong.
Steve
Just read last evening about the health care plan that has been a part of Massachuettes since 2006, that has been a success story there, it was part of the basis for the plan that we will all be a part of. It seems to be making a good positive impact not a negative for the taxpayer. We, as taxpayers have already been paying for issues that have plaqued the healthcare system for a long long time, …uninsured people of all ages having to utilize emergency rooms for non emergency problems. Many don’t have the money to pay for the service to begin with…that in turn drives the cost of healthcare up as the hospitals try to recover the lost income and revenue. There has got to be a better way than that.
On a different note it makes me wonder WHY in 13 years the cost of nursing home/assisted living care has doubled to tripled in cost. My family was charged 3600.00 for a private room/private pay for my mother in 1999 in a suburban nursing facility and currently I work in an MCO who now pays that for a Mcaid bed in a semi private room. …The CNAs are being paid less than they were then and the RN’s are making the same so where is the cost coming from?
Not all facilities have their RN’s and CNA’s in a union.
In response to Steve: there is provisions in the Bill for where the additional funding would come from … there is an easily read version of it on the healthcare.gov website.
As a healthcare professional there are many pro’s and con’s to what will happen with the new Healthcare Reform Act being passed. But the one thing that I know for a fact is that the Average American has no idea of how the system was created, how it works and what’s the best way to get the most affordable healthcare product for themselves or their family. Why???? Americans have been trained to believe that they need someone else to tell them what to do, how to do it, when to do it and who to follow to get it. Most people do not know how to think for themselves and they seem to gravitate toward being “lead around” with an invisible collar that can be jerked here or there. If someone controls your mind (your thoughts) they’ll definitely control your body.
I see more positive pluses with a minimal amount of downside problems because I’m not outside looking in I’m inside the industry. Here’s an example of what I mean: if you never processed any type of health or insuance claim how would you start? You couldn’t start the process because you don’t know what to do first! You would first need to “learn what a claim is, the codes, the processing, who is eligible or ineligible to receive payment, how to read the codes and then begin processing the claim” for that particular industry. No one can perform a task unless they have acquired the knowledge to implement the process. This is true of any industry anywhere in the world. And this same principle applies to the new healthcare reform. People that are not sick shouldn’t stress themselves about paying for an affordable healthcare program – notice I didn’t say “insurance”. People who are eligible for state assistance through MEDICAID need to enroll. People who don’t believe that they should have a healthcare program in place are leeches. They know how the healthcare system works and they’ve taken advantage of it for years. But these are the same people who are not sickly.
Were you aware that there is a law in existence that makes it mandatory for hospitals to treat anyone that comes through their doors for care? That means that “we the people” need to understand and get involved in learning how our healthcare system works and then get involved in helping our fellow man learn how to utilize the systems that are available to them without costing “we the people” an arm and leg for an affordable healthcare program. Change the way you view “health” and you’ll live longer. What would happen if no one needed to take a pill?
I agree with Emilie and David I believe. It seems to me that while there are going to be problems it is time that something has to be done. Healthcare has been an issue sine the 1930’s and this is the first attempt to do something about it. Fixing the mistakes along the way is just part of the process. Probably not at first but I hope the American people end up being the winners. Other civilized countries have done it and there is no reason why we can’t also. The losers in all of this from my point of view has been the citizens of this great country. Preventive care alone shouls save millions, if not billions, of dollars. It is a mind set that “we” will have to change and address because at this time we do not practise it here.
I agree with Emilie and David I believe. It seems to me that while there are going to be problems it is time that something has to be done. Healthcare has been an issue sine the 1930’s and this is the first attempt to do something about it. Fixing the mistakes along the way is just part of the process. Probably not at first but I hope the American people end up being the winners. Other civilized countries have done it and there is no reason why we can’t also. The losers in all of this from my point of view has been the citizens of this great country. Preventive care alone should save millions, if not billions, of dollars. It is a mind set that “we” will have to change and address because at this time we do not practise it here.
From LinkedIn Groups
LinkedIn Groups
Group: Senior Living & Care Professionals
Discussion: Does Senior Housing Win, Lose or Draw, with ObamaCare? Part 2
Your point is well taken but you must remember how this industry disparity was created. Back in the day, nursing profession did not have a union. All, if not most, of the trades have a union that oversees and governs what their hourly wage is, along with the benefits they receive while working and after they retire so long as they pay their union dues. CNA’s and other direct care worker positions are not unionized as yet and therefore are subject to whatever the “going rate” is for service. Healthcare professionals understand the disparity and they’re truly working hard to get this problem corrected but like anything else, it will take time, education and most of all the willingness of the “care providers” to gently demand better wages for the long hard work they perform in caring for the needs of others.
Posted by gLou Coleman-Stevens
Group: Senior Living & Care Professionals
Discussion: Does Senior Housing Win, Lose or Draw, with ObamaCare? Part 2-The Losers http://seniorhousingforum.net/2012/07/obama-care-and-senior-housing-part-2-the-losers/
I disagree totally with your article. It was skewed and biased and offered no evidence. Where were you getting your information? I agree with Emilie (one of the commenters after the article). Get your facts straight and don’t just spew Republican propaganda. What our national health care plan really means is that now tens of millions of Americans won’t be doing without health care or they won’t have to visit emergency rooms for every ill and have it written off by the providers. It was a disgrace that a supposed developed country such as ours was ignoring the basic needs of a fifth of its population.
Posted by Regina Ford, MBA, CAPS
Steve Moran • Interesting discussion. Regina, I am kind of surprised at the harshness of your comment. You are right that the plan will make it possible for a whole new class of people will have access insurance or insurance like coverage. But this coverage comes at a cost to tax payers. Prior to ObamaCare, many of these individuals received their primary care at emergency rooms and hospitals and physicians built those freebies into their overall financial picture.
With ObamaCare they will begin to see reimbursement for the many of those patients (but not all). Yet I have not seen even a hint of a suggestion that other rates will be reduced to accomplish this. So the net effect is that the Affordable Care Act will cost the government more money than it was spending before and that money can ultimately only come from the Tax Payers.
To be more specific you state the following: “I disagree totally with your article”. Which part do you disagree with? That it will cost tax payers more money; that it will ultimately hurt Drug Companies; That it will hurt DME providers; That it will hurt physicians.
I have not actually expressed an opinion on universal health care so I feel your harsh words are unwarranted, but I honestly do appreciate that you are part of the discussion.
Steve
From LinkedIn Groups
Regina Ford, MBA, CAPS • Sorry about that, Steve. I think reading your article reminded me of a Michelle Bachman interview I saw recently. I would have appreciated some citations to back up your assertions.
From LinkedIn Groups
Steve Moran • Hi Regina:
No problem. My politics are generally pretty conservative and I am not really a fan of ObamaCare, because in order to get it passed, it included a lot of other social engineering.
I guess I am not a true conservative though, because while in the theoretical world I would prefer to not see universal care, the reality of our system is that healthcare has become so expensive that if both parents in a family end losing their jobs and therefore healthcare, the cost to even pay COBRA is for many families out of reach. Further, if someone is entrepreneurial, not having easy access to insurance becomes a terrible barrier to starting a new business.
It is hard to provide citations, because mostly what I wrote is speculation based on what I know about the bill and looking at the implications of the new system.
Steve
While it is true that the current system has been rife with problems, government influence has caused a lot of those problems to arise in the first place. Every doctor wh has taken Medicare patients over the last two decades will tell you that part of the cost of care for those patients is borne by the rest of their patients. The reimbursements have never been equal to even their negotiated insurance rates, hence the trus cost is brone by their other patients due specifically to the government not paying its “fair share” of costs. So if I am not convinced the ACA will drive down costs and insurance rates for the rest of us, I’m sorry. I personally have three sons who range in age from 20 – 26 and they each have what we call a catastrophic care policy. It costs roughly $100/month and has a $3,000 deductable. They pay for visit to deal with colds and stuff and never spend more than $250/year fr these services. That makes their net cost of health care and insurance $1,450/year. Under the ACA these policies will be gone replaced with full service policies that begin paying from the first dollar. We priced those plans as well and the cost would have been between $350-$425/month, or $4,200-$5,100/year. My son’s attitudes were the current policies were no brainers and the ACA was nothing more than a plan to transfer the cost of care for aging baby-boomers to their generation. Forget the talk of wealth transfers from the rich to the poor, the ACA really transfers the earnings of our children to cover the cost of health care for the aging baby-boomers. There are many technicalities in the law, but the overall plan is really justifying the cost transfer. A new plan that really works fairly for all economically is the answer.
From Linked Groups
Group: Senior Living & Care Professionals
Discussion: Does Senior Housing Win, Lose or Draw, with ObamaCare? Part 2-The Losers http://seniorhousingforum.net/2012/07/obama-care-and-senior-housing-part-2-the-losers/
Hi Steve: I appreciate the fact that you are voicing an opinion.
I personally work with seniors as a state contracted distributor of medical supplies for low income residents and we also provide an in-home care service to any senior, disabled person or caregiver in need of assistance.
The housing piece that you spoke about is not going to be affected by the healthcare reform for seniors living in housing units that accommodate low-income seniors. Seniors who choose to move into adult senior apartments are able to paying the rent so they are not affected by the changes.
There are several non-insurance alternative healthcare programs in the country. The problem is people don’t know that they exist. These private corporations rely on their healthcare partners to get the word out about their services to the public. In fact, I market such a program to the seniors and anyone that is self employed or operates a small business. The cost of these benefit packages are very affordable and they are available throughout the U.S. thus making it the perfect healthcare product for anyone who is in need of an affordable healthcare product.
Most of us, as Americans, have been trained to accept whatever is offered to us by representatives of healthcare companies,i.e…. BC/BS, MCO’s, PPOs, HMOs. I know I did when I was an employee. Why? Because we choose to believe that the representatives have our best interest at heart. They’re inside the industry and should know which programs are affordable. But people forget that these companies are in business to make a profit thus their reps are not going to assist you in locating a program that will fit your budget. It’s sad but true.
Anyway, back to the topic at hand. A large percentage of the senior population has chosen to “age in place at home”. Those who live in an assisted living facility or residential congregate home or living with a family member is not going to be adversely affected by the new healthcare reform bill. In fact, within the DMV, we’re seeing the construction of senior apartments being built to accommodate seniors who want to “age in place”. They obviously have the means to acquire “in-home care/assistance” for their basic daily activities. And for those seniors who, due to a decline in their health, have opted to move into residential assisted living home or congregate homes.
gLou Coleman-Stevens
Posted by gLou Coleman-Stevens